Active NPI
Chanelle Nicole Clark
- Behavior Technician
- Lynn, MA
National Provider Identifier
1992407852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- S64679223
- Practice address
- 37 Kingswood LN
Lynn, MA 01905-3118 - Phone
- (781) 476-3013
- NPI assigned
- Mar 21, 2023
- Last updated
- Mar 21, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | S64679223 | MA | Primary |
Addresses
Primary practice location
37 Kingswood LN
Lynn, MA 01905-3118
Mailing address
37 Kingswood LN
Lynn, MA 01905-3118
Phone (781) 476-3013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S64679223 | MA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679356800000",
"number": "1992407852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 KINGSWOOD LN",
"city": "LYNN",
"state": "MA",
"postal_code": "019053118",
"telephone_number": "781-476-3013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37 KINGSWOOD LN",
"city": "LYNN",
"state": "MA",
"postal_code": "019053118",
"telephone_number": "781-476-3013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CHANELLE",
"middle_name": "NICOLE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-21",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MA",
"license": "S64679223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.